In psychiatry, perhaps more than in any other field of medicine, diagnosis depends on clinical judgment, as there exist few physiological markers of specific psychiatric illnesses. Structured interview methods, such as the Structured Clinical Interview for DSM-IV-TR (SCID), yield more accurate and reliable diagnostic judgments than do the type of unstructured patient interviews that predominate in clinical settings. The SCID, however, remains an unattractive option to most clinicians, in part because it is a lengthy and complex paper-and-pencil instrument that requires extensive training to learn to administer it correctly. Additionally, the paper SCID is costly and cumbersome to reproduce and store. Computer-assisted SCID administration can alleviate both the difficulty of administering the SCID, as well as its high cost per administration. The objective of the proposed project, therefore, is to develop a computer-assisted version of the SCID ("Net SCID") that will facilitate more widespread adoption of this gold-standard diagnostic instrument by making the SCID easier and less expensive to use. During Phase I of the project, we used archival and simulated SCID data to develop a database-driven, Internet-based functioning prototype that automates the complex branching and diagnostic logic of the paper-based SCID. In Phase II, we will 1) develop a commercial-quality user interface and diagnostic reporting tool for the Net SCID;2) conduct side-by-side comparisons of the paper and Net SCIDs with live patient responses to establish the usability of the Net SCID for live interviewing, and assure that the Net SCID produces the same diagnoses in response to live responses as does the existing paper SCID;and 3) compare the performance of the Net SCID to that of the paper SCID with respect to interview duration, ease of administration, and user satisfaction. In addition, we will implement and test computer-assisted versions of variations of the SCID (including the Clinician Version) and make several improvements to the Net SCID that will enhance its commercial viability, such as providing an online help feature and the ability to store HIPAA- compliant databases of item responses and diagnoses for statistical analysis. PUBLIC HEALTH RELEVANCE: The Structured Clinical Interview for DSM-IV-TR (SCID), a lengthy and complex paper-and-pencil instrument, yields more accurate and reliable psychiatric diagnoses than do the type of unstructured patient interviews that predominate in clinical settings. The SCID, however, remains an unattractive option to most clinicians, in part because of the extensive training necessary to learn to administer it correctly, and because it is costly and cumbersome to reproduce and store. The objective of the proposed project, therefore, is to develop an Internet-based computer-assisted version of the SCID (Net SCID) that will facilitate more widespread adoption of this gold-standard diagnostic instrument by making the SCID easier and less expensive to use.